by Ronald Hirsch, MD FACP CHCQM CHRI
Feb 22nd, 2023
It happens more often than you might expect.
One topic I often speak about is patient notices. Don’t we all love them? We all know no one really reads them until something goes wrong, and then you better be darn certain you did it right.
Recently I discovered something very interesting about one of the outpatient service notices. If you provide an Advance Beneficiary Notice of Non-coverage (ABN) to a Medicare patient for an outpatient service that you have determined does not meet Medicare coverage guidelines and they sign it, agreeing to pay, the billers will place a -GA modifier on the claim – informing the Medicare Administrative Contractor (MAC) that the hospital does not feel this is a covered service, that the patient agreed to pay, and that a signed ABN is on file at the hospital.
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This article originally published on February 22, 2023 by RACmonitor.
About Ronald Hirsch, MD FACP CHCQM CHRI
Ronald Hirsch, MD, is vice president of the Regulations and Education Group at R1 Physician Advisory Services. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, a member of the American Case Management Association, and a Fellow of the American College of Physicians. Dr. Hirsch is a member of the RACmonitor editorial board and is regular panelist on Monitor Mondays. The opinions expressed are those of the author and do not necessarily reflect the views, policies, or opinions of R1 RCM, Inc. or R1 Physician Advisory Services (R1 PAS).